1 / 10

Prehospital Point of Care Testing Paul A. Berlin, MS, NREMT-P

Prehospital Point of Care Testing Paul A. Berlin, MS, NREMT-P. EMS POC is here today Provides EMS providers with valuable information leading to better treatment plans Can help direct patients to appropriate receiving centers Increases capability and professionalism of EMS providers.

akasma
Download Presentation

Prehospital Point of Care Testing Paul A. Berlin, MS, NREMT-P

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Prehospital Point of Care TestingPaul A. Berlin, MS, NREMT-P • EMS POC is here today • Provides EMS providers with valuable information leading to better treatment plans • Can help direct patients to appropriate receiving centers • Increases capability and professionalism of EMS providers

  2. Point-of-Care Testing • POC devices fall into two general categories: • QUANTITATIVE devices which are normally an electronic instrument that measures the quantity of whatever substance is being tested for in a blood sample (an example of which would be an electronic glucometer which shows the blood sugar in mg/dL) • QUALITATIVE devices which usually contain chemically treated paper that changes color to indicate the presence of the specific substance being tested for (an example of which would be a colormetric CO2 detector)

  3. Measure What? • Electrolytes: Sodium, potassium, chloride, BUN, anion gap, base excess, bicarbonate, glucose levels • Blood: Hematocrit, hemoglobin • Blood Gas: pH, CO2, PO2 • Coagulation: Prothrombin time • Cardiac enzymes: Cardiac troponin-I, BNP, CK-MB, myogloblin and H-FABP • And More

  4. Getting POC • Costs: $--$$$$ • Cartridges • Analyzers • Accessories • Service Contract • Regulations: • Clinical Laboratory Improvement Amendments (CLIA) • CMS

  5. 80 Year Old Female • Decreased LOC • Likely been on the floor for days • Her BP is 70/50 mm/Hg, pulse is 60 bpm, respirations are 8/min and she only responds to deep pain POC test shows potassium (K+) of 9.2 mEq/L (3.5-5.5 mEq/L). • Treatment plan now includes giving CaCl2, Bicarbonate and Albuterol.

  6. 56 Year Old Female • Reports intermittent, “funny feeling” in her right arm and neck for the past four days. She has a history of hypertension and takes medication. She is diabetic. She wants to stay home. Troponin I on this patient is 8.5

  7. 37 Year Old Marathon Runner • Complains of headache and confusion 30 minutes after finishing. • Suddenly has tonic-clonic seizure lasting 90 seconds. • Electrolytes: • Sodium 112 mEq/L (135-148 mEq/L) • Potassium 3.5 mEq/L (3.5-5.5 mEq/L) • Glucose: • 90 mg/dL (60-99 mg/dL) • Dx: Dilutional Hyponatremia

  8. Respiratory Distress • Elderly patient with a recent strokeand a history of coronary artery disease calls 911 for help • On examination, he has expiratory wheezing, tachypnea and is nowstuporous • Oximetry reads 96% on 6 L oxygen flow by nasal cannula • Temperature is 96.7° F orally • An ECG shows a left bundle branch block • B-type natriuretic peptide (BNP) is 1100 pg/ml indicating heart failure.

  9. Getting POC • Training: • Sample handling • Unit operations • Annual refresher • QA: • Testing the test • Oversight • Expectations of ED • Will the except your test • Getting “buy-in”

  10. References • 1. Part 10.1: Life-Threatening Electrolyte Abnormalities. Circulation. 2005;112:IV-121-IV-125. • 2. Part 8: Stabilization of the Patient With Acute Coronary Syndromes. Circulation. 2005;112:IV-89-IV-110 • 3. Part 10.1: Life-Threatening Electrolyte Abnormalities. Circulation. 2005;112:IV-121-IV-125. • 4. Differentiating the Causes of Metabolic Acidosis in the Poisoned Patient. Clinics in Laboratory Medicine - Volume 26, Issue 1 (March 2006) • 5. Modern Management of Cardiogenic Pulmonary Edema. Emergency Medicine Clinics of North America; Volume 23, Issue 4 (November 2005). • 6. Part 9: Adult Stroke. Circulation. 2005;112:IV-111-IV-120 • 7. Point-of-Care Testing and Cardiac Biomarkers: The Standard of Care and Vision for Chest Pain Centers. Cardiology Clinics - Volume 23, Issue 4 (November 2005) • 8. Point-of-Care Testing Reduces Length of Stay in Emergency Department Chest Pain Patients. Annals of Emergency Medicine - Volume 45, Issue 6 (June 2005) • 9. Patient safety in point-of-care testing. Clinics in Laboratory Medicine - Volume 24, Issue 4 (December 2004)

More Related